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Genetic testing by oncology providers with referral to cancer genetic specialists, when appropriate, for patients with epithelial ovarian cancer (EOC) is feasible as an alternative care delivery model, as reported in a recent study in . A shortage of genetic counselors can affect timely access to germline genetic testing for EOC patients, however, and the researchers set out to investigate the current genetic testing practices of oncology providers to determine the feasibility of oncologist-led genetic testing for this group of patients.

In this exclusive 番茄社区 interview, , section head of Obstetrics and Gynecology and the Women's Health Institute at the Cleveland Clinic, reviews the results of the study and offers his takeaways.

The following is a transcript of his remarks.

I'm Robert DeBernardo. I am the section chief of GYN Oncology at the Cleveland Clinic. I also hold an endowed chair for endometrial cancer research and lead our peritoneal surface malignancy program here. So today we're going to talk about a paper about mainstreaming genetic testing for epithelial ovarian cancer patients by oncology providers. I think this is a really important topic. And there's not a lot really known about it.

So ovarian cancer is obviously a very deadly disease and is driven mostly because it's detected late. And what's interesting is 10-25% of patients have a genetic predisposition that leads them to this cancer. So since we have excellent risk-reduction strategies for these patients detecting this ahead of time, this risk is really important. So the authors of this paper, really what they try to do, was look at what practices are going on in the states with people referring and how many patients are actually getting referred for testing.

So what's unfortunate is only 35% of women with ovary cancer are being referred. So what the authors did in this paper is they surveyed the membership of the SGO [Society of Gynecologic Oncology], which is the major organization for gynecologic oncologists. And they had about 170 responses. And basically it turned out that about 85% of the people who responded always referred patients for genetic testing. And the vast majority of that was germline, which is what we would prefer to see. And of those patients, about 65% were referred at the time of the initial diagnosis or there abouts.

So I think this is important information to look at. Given that only 35% of ovarian cancer patients are tested, I think this is something that we need to kind of work on. Some of the other things that the authors discovered was that, of the people that always referred for genetic counseling, the vast majority of people were comfortable ordering these tests, interpreting them, as well as counseling patients.

I have to say some of the things that make me a little more concerned in this paper is that you're dealing with the majority of people that responded were in academic institutions, where genetic counseling is much more common. There's a shortage of genetic counselors. So these results may not indicate everything that's going on across the country. And given the membership in SGO, 170 responses is not a ton. It represents about 10% of the membership, so I think we have to keep that in mind.

So I guess as a takeaway point, I think we really need to do a better job of getting these women tested. Since one in four, one in five, are going to have a genetic reason for ovary cancer, we can prevent these cancers from occurring in people that are screened.

Just to review a couple of numbers, 40-60% of BRCA patients can develop ovarian cancer, 5-10%, 20% of Lynch carriers can. And, that's compared to the lifetime risk of 1-2% for one without genetics.

So I think this is a really interesting paper and well done.

Read the study here, an interview about it here, and an additional critique about the clinical implications here.